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ECHO 325 > Congestive Heart Failure > Flashcards

Congestive Heart Failure Flashcards

1
Q

What is cardiac failure?

A

State in which the heart is unable to meet the oxygen and metabolic demands of the body

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2
Q

Cardiac failure may be present in both a resting state or during exertion. Which is worse?

A

Cardiac failure during resting state

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3
Q

Left heart failure is caused by the disease of what three things?

A

Myocardium, valves, coronary arteries

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4
Q

What is a BIG contribution to left heart failure?

A

Leaky valves

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5
Q

What is the #1 cause of RHF?

A

LHF

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6
Q

Right heart failure is caused by the disease of what 3 things?

A

Lung parenchyma, lung vascularity, and cor pulmonale (Right heart enlargement).

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7
Q

Left heart failure can be classified as either what two things?

A

Forward systolic failure and backward diastolic failure

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8
Q

What does the EF look like in forward systolic failure?

A

Reduced

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9
Q

What does the EF look like in backward diastolic failure?

A

Normal

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10
Q

Forward systolic failure is also known as what?

A

HFrEF

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11
Q

Backward diastolic failure is also know as what?

A

HFnEF

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12
Q

What does HFrEF stand for?

A

Heart Failure reduced EF

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13
Q

What does HFnEF stand for?

A

Heart Failure normal EF

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14
Q

What would the EF be in HFrEF?

A

<40%

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15
Q

What would the EF be in HFnEF?

A

> 55%

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16
Q

What happens in forward failure?

A

Impaired ventricular contraction, most commonly from ischemic heart disease

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17
Q

What percentage of all CHF are due to forward failure?

A

50-60%

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18
Q

What happens in backward failure?

A

Impaired ventricular relaxation, most commonly from hypertension and left ventricular hypertrophy

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19
Q

What percentage of all CHF are due to backward failure?

A

40-50%

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20
Q

Why does left heart failure lead to right heart failure?

A

Filling pressures rise and back up

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21
Q

What three things is LVH caused by?

A

Aortic stenosis, high BP, age

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22
Q

Reduced compliance in the LV leads to what two increases?

A

Increase in LV and LA filling pressures

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23
Q

What are the four stages of backwards failure?

A
  1. Elevation of LV end diastolic pressure
  2. Elevation of LA pressure
  3. Elevation of pulmonary pressures
  4. Elevation of right heart pressure
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24
Q

What are the six symptoms of left-sided CHF?

A
  1. Dyspnea (difficulty breathing due to pulmonary congestion)
  2. Orthopnea (difficulty breathing while laying down)
  3. Parxysmal Nocturnal dyspnea
  4. Acute pulmonary edema
  5. Fatigue (due to low cardiac output)
  6. Palpitations (mitral valve being shittyy)
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25
Q

What are the seven signs of left-sided CHF?

A
  1. Cardiomegaly (dilation as seen on x-ray)
  2. Ventricular heave (LV pushes against the chest wall)
  3. 3rd heart sound (early filling)
  4. 4th heart sound (decreased compliance)
  5. Rales or crackles (sounds while breathing)
  6. Cheyne-Stokes respiration (start and stop respiration)
  7. Tachycardia (as CO reduces, HR increase)
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26
Q

Other than left-sided failure, what three things cause right-sided failure?

A

Pulmonary hypertension, chronic obstructive pulmonary disease, emphysema

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27
Q

What are seven signs of RV failure?

A
  1. RVH (high afterload)
  2. Murmur (Pulmonary and tricuspid regurg)
  3. Wheezing
  4. Elevated jugular venous pulse
  5. Pitting edema
  6. Ascites
  7. Cyanosis
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28
Q

What are four symptoms of RV failure?

A
  1. Fatigue (Due to reduced CO)
  2. Dependent edema (Ankles when upright, sacral and abdomen when supine)
  3. Liver engorgement (RUQ pain)
  4. Anorexia or bloating (Due to hepatic or visceral engorgement)
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29
Q

What is PCWP?

A

Pulmonary capillary wedge pressure

30
Q

What is the gold standard for measuring pulmonary pressure?

A

Pulmonary Capillary Wedge Pressure (PCWP)

31
Q

What is normal LAP?

A

6-12 mmHg

32
Q

What pressure of the LA might suggest pulmonary hypertension?

A

> 18 mmHg

33
Q

What are the Functional CHF Categories?

A

1: No symptoms, no limitations, have signs
2: Mild symptoms, some limitations
3: Marked limitations due to symptoms
4: Severe limitations

34
Q

Venous return if affected by which three things?

A

Blood volume, venous pressure, and intrathoracic pressure

35
Q

What is a fake formula you can use to remember the relationships relating to venous return?

A

Venous return = (BVxVP) ÷ IP

BV: Blood volume
VP: Venous pressure
IP: Intrathoracic pressure

36
Q

Venous return affects preload due to EDV directly or indirectly?

A

Directly

37
Q

High afterload reduces stroke volume by increasing or decreasing the end-systolic volume in the LV?

A

Increasing

38
Q

Afterload is increased by what three things?

A

High BP, aortic stenosis, and coarctation of the aorta

39
Q

As afterload increases, stroke volume should increase or decrease?

A

Decreases

40
Q

What are four factors that affect heart rate?

A

Autonomic innervation, hormones, fitness levels, age

41
Q

What are seven factors that affect stroke volume?

A

Heart size, fitness levels, gender, contractility, duration of contraction, preload, afterload

42
Q

What is the equation for CO?

A

HR x SV

43
Q

What is the equation for SV?

A

SV = EDV - ESV

44
Q

Does the parasympathetic or sympathetic nervous system decrease the HR?

A

Parasympathetic

45
Q

Which nerve decreases the heart rate?

A

Vagus nerve

46
Q

Whats serves to preserve cardiac output and blood pressure?

A

Compensatory mechanisms

47
Q

Sympathetic/Parasympathetic nervous system, Frank-Starling mechanism, and the renin-angiotensin-aldosterone mechanism are all examples of what?

A

Compensatory mechanisms

48
Q

The sympathetic nervous system causes what kind of response?

A

Fight or flight

49
Q

As BP drops, what happens to HR and contractility?

A

Both are increased

50
Q

Cardiac output is decreased. Which three events will increase to stabilize?

A

Sympathetic nervous system

51
Q

When are compensatory mechanisms detrimental to the body?

A

Long-term

52
Q

Which lab values would you see increased in someone whose body is trying to counteract the compensatory mechanisms?

A

Atrial natriuretic peptide (ANP)

B-type natriuretic peptide (BNP)

53
Q

Which hormone is tested to see if someone is in CHF?

A

B-type natriuretic peptide

54
Q

Under what conditions would you add 3 mmHg to RAP?

A

Normal IVC at ≤21 mm with 50% collapse with sniff

55
Q

Under what conditions would you add 15 mmHg to RAP?

A

Abnormal IVC >21 mm with <50% collapse with sniff

56
Q

Under what conditions would you add 8 mmHg to RAP?

A

Only one criteria is met to be abnormal

57
Q

What type of medication can be used to reduce intravascular volume, preload, and afterlaod?

A

Water pills

58
Q

What is the purpose of inotropic agents?

A

Improve contractility

59
Q

What are examples of inotropic agents?

A

Digitalis and digoxin

60
Q

What do ACE inhibitors do?

A

Block angiotensin converting enzyme

61
Q

What are the effects of ACE inhibitors?

A

Arterial and venous vasodilation

62
Q

Drugs ending in ‘pril’ are usually what?

A

ACE inhibitors

63
Q

What do beta blockers do?

A

Slow force of contraction and heart rate

64
Q

Medications ended in ‘olol’ are usually what?

A

Beta blockers

65
Q

A-fib decreases stroke volume and increases the risk of what?

A

Clot formation

66
Q

Since people with a-fib are at risk for clot formation, what must they be on?

A

Anticoagulants

67
Q

People with atrial arrhythmias must be on anti-arrhythmics such as what three things?

A

Calcium channel blockers, lidocaine, beta blockers

68
Q

What specific term is for reducing the risk of thrombus formation?

A

Prophylactic anticoagulation

69
Q

What are some examples of prophylactic anticoagulation?

A

Heparin, clopidogrel, warfarin, ASA

70
Q

What are some other anti-arrhythmic options other than medication?

A

Pacemakers (biventricular pacing), implantable cardioverter/defibrillators, LV assist devices

ECHO 325 (19 decks)

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